Objective:

To investigate the predictive ability of the Atherogenic Index of Plasma (AIP) and its modified indices for all-cause mortality in rural low-income populations with different blood pressure statuses, and to compare these predictive abilities with the Triglyceride-Glucose (TyG) index.

Key Findings:

• 1,024 cases of all-cause mortality were recorded during a median follow-up of 8.82 years.
• In the hypertensive group, TyG and AIP showed significant negative associations with all-cause mortality (all P < 0.001).
• AIP and its modified index demonstrated stronger protective associations compared to the TyG-based index.
• A one-unit increase in AIP-WHtR was associated with a 79% reduction in the risk of all-cause mortality (HR: 0.21, 95% CI: 0.18–0.25, P < 0.001).
• No significant associations were found in the non-hypertensive group (all P > 0.05).
• AIP and its modified indices had better predictive ability for all-cause mortality than TyG and its modified indices.

Interpretation:

AIP and its modified indices are significantly negatively associated with all-cause mortality in hypertensive individuals, with a non-linear relationship observed, suggesting potential clinical implications for risk stratification.

Limitations:

• The study is limited to a rural low-income population, which may affect generalizability.
• Potential confounding factors not accounted for in the analysis.
• The observational nature of the study limits causal inferences.

Conclusion:

AIP and its modified indices are better predictors of all-cause mortality in hypertensive individuals compared to TyG and its modified indices, highlighting their potential role in public health strategies.